Change in health

When we’re looking at complaints involving a mid-term change in health, we’ll consider whether there has been a significant change in your health, which altered the subject matter of the risk being insured, that you should have realised was important enough to tell the insurer about.

An insurer can change or end an insurance contract if your circumstances change during the course of the policy which significantly alters the insured risk.

If your travel policy asks you to, you should tell insurers about significant changes to your health when you become aware of them– even if you’re waiting for a diagnosis. A significant change in risk is a change which alters the subject matter of the risk being insured.

Travel insurers may try to get more information about your health during your insurance contract, by including a ‘change in health’ term on the policy. The term might say something like: “If, after purchasing this policy, any insured person develops a new medical condition, or has a change in a medical condition already declared to us, you must contact us.” 

Policy terms like these are examples of where the insurer could be attempting to restrict cover for conditions that become apparent after the policy has started. It’s fair for insurers to do this – but they need to make sure that the relevant policy term has been applied in a fair and reasonable way. 

If you have a less serious medical condition, you may not necessarily realise the importance of updating your insurer. This could be when you’ve had a minor cough or cold that resolved very quickly. In these cases, we’d expect your insurer to take this into account.

• An example of a significant change in health could be the diagnosis of a serious medical condition like:
• diabetes
• heart conditions
• stroke
• cancer, or
• other serious medical conditions.

But it could also include other situations, for example, if:

• you’ve been in hospital for a long time
• you were going to have a major operation close to the date of your trip
• you’ve recently been diagnosed with a medical condition needing ongoing care
• you are undergoing investigations for an undiagnosed condition.

We’ll consider whether:

• the risk is so different now that it would be fair for the insurer to change the terms of the policy
• a reasonable person should have realised the change in health might impact their holiday.

Even if the condition hasn’t actually been diagnosed, we might still think there was a significant change in your health.

For example, if you were referred urgently to a consultant because of symptoms you were having, then we might think this is a significant change in health which you should tell your insurer about. We may not expect you to wait for a formal diagnosis before recognising that you’re experiencing a significant change in health.

If your doctor referred you for routine or minor tests, that doesn’t automatically mean you have a significant change in health that you should report to the insurer. But, the outcome of each case will depend on the individual circumstances. 

If you told your insurer about a change in health, they might:

• cover the medical condition for no additional premium
• charge an additional premium to provide cover for the medical condition
• apply an exclusion to the policy about the medical condition
• withdraw cover altogether

If we don’t think there has been a significant change in health, then we don’t think it’s fair for your insurer to alter the terms of the contract mid-term. 

If we think there has been a significant change in health, then we may think it’s fair for your insurer to alter your contract – as long as they can provide evidence to support what they’re doing and why.

If your insurer withdraws cover entirely, we’d generally expect them to offer to cover the costs of cancelling any holiday which was due to be taken during the policy year. Even if cancellation isn’t medically necessary at that point, we think this is the fair and reasonable thing for insurers to do. And, we wouldn’t generally expect to see an insurer deducting an excess from that payment.

Often, you may want to go on the holiday anyway, so you’ll find cover elsewhere. We might think it’s fair for your current insurer to pay the difference in premium charged by the new insurer, up to the value of what any holiday cancellation claim would have been at the time of the significant change in health.

We’d generally expect any new policy to have a similar level of cover to the original policy.

Your insurer may say that your claim isn’t covered because they would have made a change to your policy if you’d told them about the change in your health.

If we don’t think there has been a significant change in health, then we wouldn’t think it’s fair for your insurer to retrospectively amend the cover.

If we think there has been a significant change in health that you should have told your insurer about, we’ll need to consider when we think it would have been reasonable for you to tell your insurer about the change.

This isn’t necessarily the day of the diagnosis (or urgent referral), because it’s not always reasonable to expect someone who’s just had bad news about their health to think to call their insurer straight away. But we think it’s fair to expect that you should generally have called within a reasonable amount of time.

If we think you should have told your insurer about a significant change in health, we’ll consider what your insurer would have done if you’d told them.

If your insurer can provide evidence that they would have covered the condition for an additional premium from the time the significant change in health occurred, then we’ll generally consider it’s fair for them to pay your claim, minus any additional premium which would have been charged.

This outcome puts both parties back into the position they would have been in had the policyholder told the insurer about the significant change in health at the time.

In this scenario, we don’t generally think it’s fair and reasonable for an insurer to attempt to settle a claim proportionately. For example, only offering to pay a percentage of the claim value, based on the percentage of the correct premium that’s been paid.

If your insurer can show us that they would have withdrawn cover entirely, we’d usually ask them to pay what the value of the holiday cancellation claim would have been if you’d told them about your significant change in health at the relevant time.

When looking at complaints about charges for cancelled trips, we’ll take account of the travel company's cancellation policies. Usually, the closer it is to the date of the trip, the larger the charge will be – up to the full cost of the holiday.

We’d usually say it’s fair for the insurer to pay the amount that would have been charged at the time we think you should have called to tell the insurer about your change in health.

So, if you’ve made payments towards the cost of your trip after you became aware of a significant change in health that you’ve failed to tell your insurer about, your insurer may only be liable to cover the payments you made prior to your change in health.